What is testicular cancer?

Testicular cancer occurs when cancer cells grow in the tissues of one or both testicles. The testicles are male sex organs that make and store sperm. They also make the male sex hormone testosterone. Testicular cancer is one of the most curable types of cancer.

Treatment involves surgery to remove the affected testicle. You may also have radiation or chemotherapy. Some people will have surgery to remove cancer that has spread to other parts of the body, such as to lymph nodes.

In most cases, the first sign of testicular cancer is a change in the size or shape of one or both testicles (testes). Often this change doesn't cause pain, though pain may be present. If unnoticed or untreated, testicular cancer may spread (metastasize) to other areas of the body.

After you are diagnosed with testicular cancer, you and your doctor will start to plan your treatment. Nearly everyone who has testicular cancer has surgery. After surgery, you may have other treatments, if they are needed. This depends on your choices, the type of cells involved, and the stage of your cancer.

Testicular cancer is one of the most curable forms of cancer, especially during its early stages. If you have symptoms, see a doctor as soon as possible.

Common symptoms of testicular cancer include:

• A swelling and/or lump in one or both of the testes. You may or may not have pain in the testes or scrotum.
• A heavy feeling in the scrotum.
• A dull pain or feeling of pressure in the lower belly or groin.

Sometimes these symptoms can be caused by other problems, such as a hydrocele or epididymitis.

Symptoms of advanced testicular cancer

Testicular cancer that has spread (metastasized) beyond the testicles and regional lymph nodes to other organs may cause other symptoms depending on the area of the body affected. Symptoms of late-stage testicular cancer may include:

• Dull pain in the lower back and belly.
• Lack of energy, sweating for no clear reason, fever, or a general feeling of illness.
• Shortness of breath, coughing, or chest pain.
• Headache or confusion.

Treatment for testicular cancer is based on the type and stage of the cancer and other things, such as your overall health. The main treatment is surgery to remove the testicle. This may be the only treatment you need. Sometimes there is treatment after surgery, such as chemotherapy or radiation therapy.

Retroperitoneal lymph node dissection (RPLND) is surgery often used to treat testicular cancer. It is done to remove lymph nodes that may be cancerous from the lower back and pelvis.

During the early phases of stage I nonseminoma testicular cancer, it can be very difficult to tell whether these lymph nodes are cancerous without surgically removing them first. For this reason, RPLND may be done even though there is no sign that the cancer has spread (metastasized) beyond the testes.

For many men, the greatest risk associated with RPLND may be sexual side effects. Besides the risks related to any major surgery, RPLND also may lead to a condition known as retrograde ejaculation as a result of nerve damage caused by the surgery. In retrograde ejaculation, the semen flows from the prostate gland into the bladder rather than through the penis and outside the body, resulting in infertility. Men who suffer from retrograde ejaculation typically do not have erection problems or difficulty enjoying sex.

Nerve-sparing surgery techniques can prevent retrograde ejaculation in most men who have this surgery.

Try to find an experienced surgeon and a medical center where many surgeries are done for your kind of cancer. Experience can make a big difference. You will likely have fewer side effects, and you'll recover more quickly.

If testicular cancer is suspected, your doctor will do tests. An ultrasound may be used to rule out other possible causes of a testicle problem. Blood or imaging tests may also be done. If these tests show signs of cancer, you will have surgery to remove the testicle. It will be checked for cancer.

Focus on taking care of yourself. Getting enough sleep, eating a healthy diet, and taking medicines as prescribed may help you feel better. Get some physical activity each day if you can, and make time for things you enjoy. Consider joining a support group or talking with a counselor.

Testicular cancer may be treated with:

• Surgery to remove a testicle (radical inguinal orchiectomy). Nearly everyone with testicular cancer has this surgery.
• Surgery to remove lymph nodes in the pelvis and lower back (retroperitoneal lymph node dissection, or RPLND). This may be used for nonseminoma cancer.
• Surgery to remove other areas of cancer if it has spread in the body. This is done for nonseminoma cancer, either before or after having chemotherapy.

In most cases, removing a testicle doesn't cause long-term sexual problems or make you unable to have biological children. But if you had these problems before treatment, surgery may make them worse. And other treatments for cancer may cause you to become infertile. You may want to think about saving sperm in a sperm bank. Talk to your doctor if you have any questions or concerns about sexual problems or whether you can have biological children.

You can choose to get an artificial, or prosthetic, testicle. A surgeon places the artificial testicle in the scrotum to keep the natural look of the genitals.

Some things may increase your chances of getting testicular cancer. These risk factors include:

• An undescended testicle. This is a testicle that has not moved down (descended) from the abdomen into the scrotum.
• Klinefelter syndrome. This is a genetic condition.
• A personal or family history of testicular cancer.

Most people who get testicular cancer don't have any known risk factors.